RU2453559C1 - Method of producing copolymer of sodium carboxy-methylcellulose and gossypol and use thereof in complex therapy of patients with autistic disorders and cognitive impairments - Google Patents

Abstract

FIELD: chemistry.

SUBSTANCE: invention relates to a method of producing a copolymer of sodium carboxy-methylcellulose and gossypol of formula (I) and use thereof in complex therapy of patients with autistic disorders and cognitive impairments, where a:b:c=1:(3-6):(5-7), n=40-50; molecular weight of 120000-130000.

EFFECT: high efficiency of treating mental illnesses.

11 cl, 3 tbl

Description

The invention relates to the field of organic chemistry, pharmacology and medicine, and relates to a method for producing a copolymer of sodium carboxymethyl cellulose and gossypol, its use in the treatment of patients with autistic disorders and cognitive impairment, as well as to a pharmaceutical composition based on it, intended for use in the treatment of patients with autistic disorders and cognitive impairment, combinations for treating patients with autistic disorders and cognitive impairment and a method for treating such patients.

State of the art

The problem of finding new treatments for autism spectrum disorders accompanied by severe cognitive impairment has been gaining increasing medical and social significance over the past decades due to the duration of treatment, severe disability and maladaptation of patients with autism spectrum disorders (Kovalev V.V. Child psychiatry. - Moscow, - "Medicine", - 1995, Bashina V.M., Autism in childhood. - Moscow, - "Medicine", - 1999, Maslova OI, Balkanskaya S.V., Studenikin V. .M. Et al. Cognitive nevorolo gia // Russian Pediatric Journal. - 2000.- No. 5, - P.40-41).

Autism in childhood is characterized by impaired mental development, an autistic form of contact with others, speech disorders, motor skills, stereotyped activities and behavior, leading to social maladaptation. The generally accepted concept of the etiology of autistic disorders does not exist today. The reasons can be very different - from endogenous-hereditary to exogenously organic and psychogenic. It is believed that autism in childhood has a neurobiological basis and is the result of cerebral disorders.

Known funds for the treatment of autism spectrum disorders, accompanied by severe cognitive impairment, which, in the first place, include antipsychotics. Among antipsychotics, chlorpromazine, neuleptil, haloperidol, teraligen, triftazine, eglonyl, azaleptin, and chlorprotixen can be used to treat autistic disorders with severe cognitive impairment. In addition, antidepressants (anafranil, azafen, pyrazidol, amitriptyline, etc.) and anticonvulsants (finlepsin, trileptal, topamax) are used to treat such conditions. (Bashina V.M. Autism in childhood. - Moscow, - “Medicine” - 1999; Maslova O.I., Balkanskaya S.V., Studenikin V.M. et al. Cognitive neurology // Russian Pediatric Journal. - 2000.- No. 5, P.40-41).

It should be noted that when using antipsychotics, there is a very high risk of undesirable side effects, including extrapyramidal disorders, malignant antipsychotic syndrome, etc. With prolonged treatment with these drugs, pronounced side effects of antipsychotics and other psychotropic drugs are noted: they can cause mental, neurological and somatovegetative disorders , which, undoubtedly, limits the necessary duration of antipsychotic therapy and its effectiveness.

Sometimes, as an additional means for the treatment of autistic disorders with severe cognitive impairment, nootropic drugs are used. Nootropic drugs are believed to have a direct activating effect on learning, improve memory and mental activity, i.e. cognitive functions. Among the nootropics most commonly used in the treatment of autistic disorders with severe cognitive impairment, glycine, nootropil (piracetam), encephabol (pyriditol), aminalon (gammalon), tanakan (L.M. Kuzenkova, O.I. Maslova, L . S. Namazova et al. Nootropics in cognitive neurology of childhood // Methodical manual for doctors. - M. 2008. P. 54). The appointment scheme of nootropics is selected individually. Despite the fact that, in general, nootropics are characterized by good tolerance in children with severe intellectual underdevelopment, their intake can lead to increased motor disinhibition, irritability, emotional excitability, and poor sleep. Other side effects of nootropics are also described: piracetam can cause dyspeptic disorders and exacerbation of coronary insufficiency, aminalon - dyspeptic disorders, a feeling of heat and fluctuations in blood pressure, pyriditol - nausea and headache, and in children - psychomotor agitation. In this case, piracetam is contraindicated in renal failure, pyriditol - with increased convulsive readiness.

In addition, recently, for the treatment of autistic disorders with severe cognitive impairment, the most effective use of complex therapy with the above drugs. Nevertheless, in this case, the body often has resistance to antipsychotic therapy, especially in patients with extremely severe forms of autism, which leads to the need to increase the average daily doses of drugs. Moreover, the expected effect is far from always observed, and side effects are often amplified (Avrutsky G.Ya., Neduva A.A. Treatment of mental patients: A guide for doctors, - Moscow, - "Medicine" - 1988; Tiganov A.S. Pathology of mental development, - Moscow, - "SCHOOL-PRESS", - 2004).

In this regard, the search for new additional means of pathogenetic therapy, which can improve the safety and effectiveness of the treatment of mental illness, is an important clinical and social task.

SUMMARY OF THE INVENTION

The authors of the present invention unexpectedly found that the known sodium salt of a copolymer of carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (1):

Where

a: b: c = 1: (3-6) :( 5-7),

molecular weight 120000-130000,

empirical formula:

[(C ₃₈ H ₃₉ NaO ₁₅ ) _a (C ₆ H ₁₀ O ₅ ) _b (C ₈ H ₁₁ NaO ₇ ) _c ] _n ,

possessing antiviral activity and used to treat various viral infections, can be successfully used to treat patients with autistic disorders and cognitive impairment.

The specified compound and the method for its preparation are described in RU 2270708. According to the known method, an aqueous solution of sodium carboxymethyl cellulose is reacted with an aqueous solution of iodic acid or sodium periodate in isopropyl alcohol, followed by washing of the obtained carboxymethyl cellulose dialdehyde with a mixture of isopropyl alcohol and water, acidified with hydrochloric acid, hydrochloric acid, hydrochloric acid and or gossypolacetic acid, then with an aqueous solution of sodium hydroxide and separation of the target product by solvent precipitation.

The product obtained in a known manner is contaminated with impurities of hydrochloric acid and isopropyl alcohol. In addition, working with hydrochloric acid solutions is always fraught with certain difficulties.

Therefore, the objective of the present invention was to develop an improved method for producing a copolymer of carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (1), devoid of the above disadvantages.

Thus, an object of the present invention is a method for producing a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the above formula (I), a molecular weight of 120000-130000, which involves the interaction of an aqueous solution of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0 , 80 with an aqueous solution of iodic acid or sodium periodate while passing through the reaction solution of carbon dioxide until a solution of pH 3.0-4.5 is reached, followed by the isolation of carboxymethyl cellulose dialdehyde, treatment of the floor of the product with gossypol or gossypolacetic acid, then with an aqueous alkali solution and isolation of the target product by precipitation with an organic solvent.

To isolate carboxymethyl cellulose dialdehyde, the reaction mixture, after setting the pH in the range of 3.0-4.5, is incubated at 5-8 ° C in a dark place for 15-18 hours, the obtained carboxymethyl cellulose dialdehyde is precipitated with acetone and washed with an organic solvent, preferably 70% aqueous acetone and 80% aqueous alcohol. Subsequent treatment with gossypol or gossypolacetic acid is carried out at a temperature of 18-20 ° C, followed by neutralization of the reaction mass with an aqueous alkali solution and isolation of the target product by precipitation with an organic solvent, preferably acetone.

The proposed method eliminates the work with isopropyl alcohol and hydrochloric acid solutions and provides a high yield of the target product.

Another object of the present invention is the use of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the above formula (I) in the complex treatment of patients with autistic disorders and cognitive impairment. So, in particular, the specified polymer is used in combination with a means for the treatment of cognitive disorders selected from one or more antipsychotics, antidepressants, anticonvulsants, or combinations thereof. It is most preferred to use said polymer, which is obtained by the method according to the present invention.

Another object of the present invention is a pharmaceutical composition intended for use in the treatment of patients with autistic disorders and cognitive impairment, containing as active ingredient a therapeutically effective amount of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the above formula (I ) and pharmaceutically acceptable additives.

The proposed pharmaceutical composition can be presented in the form of various dosage forms depending on the selected method of its use. For oral administration, the pharmaceutical composition can be used in the form of tablets, capsules or suspensions. In addition, for rectal administration, suppositories can be used. The amount of active ingredient in a pharmaceutical composition can vary over a wide range depending on various factors well known to those skilled in the pharmaceutical art. As pharmaceutically acceptable additives, substances commonly used for the above dosage forms can be used. For example, in tablets, starch can be used as filler, for example, potato starch, calcium or magnesium stearate, milk sugar and other pharmaceutically acceptable excipients.

Currently, the problem of reducing the number of allergenic components in pharmaceutical preparations is becoming more urgent. In this regard, the use of ludipress as a pharmaceutically acceptable additive, which contains direct compression lactose, povidone, pyrrolidone and crospovidone, can completely replace the use of milk sugar (lactose) in pharmaceutical preparations and reduce the content of such an allergenic component as starch, as well as reduce the content calcium or magnesium stearate. This increases the strength of the tablets.

In this regard, in a preferred embodiment, the proposed pharmaceutical composition may have the following composition, in% wt .:

active ingredient of the above formula (I) 10.0-16.0 starch 10.0-20.0 calcium or magnesium stearate 0.6-0.8 ludipress up to 100.

Typically, the pharmaceutical composition of the present invention is used in combination with a cognitive disorder agent selected from one or more antipsychotics, an antidepressant, an anticonvulsant, or a combination thereof.

Thus, another object of the present invention is a combination for the treatment of patients with autistic disorders and cognitive impairment, comprising a therapeutically effective amount of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the above formula (I) or a pharmaceutical composition based on it ; and a therapeutically effective amount of a cognitive disorder agent selected from one or more antipsychotics, an antidepressant, an anticonvulsant, or a combination thereof.

Accordingly, another object of the present invention is a method of treating patients with autistic disorders and cognitive impairment, comprising administering to the patient a therapeutically effective amount of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the above formula (I) in combination with a therapeutically effective amount of an agent for the treatment of cognitive disorders selected from one or more antipsychotics, antidepressants, anticonvulsants, or a combination thereof .

The method can be used to treat autistic disorders and cognitive impairment in children from the age of 6 years. The treatment regimen is selected by a specialist based on the severity of the disease, the condition and age of the patient. In particular, treatment can be carried out according to the following scheme: taking the drug 3 times a day for 5 days, followed by a 5-day break. This ten-day cycle is repeated 2 more times. The total duration of treatment is 30 days. The dose of the active substance is 36 mg / day. Next, the course should be repeated.

A medication for treating cognitive disorders is selected from antipsychotics, antidepressants, and anticonvulsants. As antipsychotics, aminazine, neuleptil, haloperidol, teraligen, triftazine, eglonyl, azaleptin, chlorprotixen are usually used. It is possible to use anafranil, azafen, pyrazidol, amitriptyline as antidepressants. Finlepsin, trileptal, topamax are usually used as anticonvulsants.

The following are examples of the preparation of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (I), as well as examples of pharmaceutical compositions based on it and a method of treatment.

Production Examples 1-8

Procedure: In a reactor equipped with a mechanical stirrer, a 3% aqueous solution is prepared from 100 g of sodium carboxymethyl cellulose (Na-CMC) with a degree of substitution of 0.35. 1600 ml of a 1% aqueous solution of iodic acid or sodium periodate are added to the resulting Na-CMC solution. After complete mixing, carbon dioxide is passed through the solution until the pH of the solution reaches 3.0-4.5. Next, the reaction mass is incubated at a temperature of 5-8 ° C for 15-18 hours. The reaction product is precipitated and washed with 70% acetone and 80% aqueous alcohol from excess oxidizer and its decomposition products. To the washed carboxymethyl cellulose dialdehyde product, gossypol (or gossypolacetic acid) is added in an amount of 15% of the initial weight of sodium carboxymethyl cellulose and stirred at 18-20 ° C. for 5 minutes. The reaction mass is neutralized with a 6% aqueous sodium hydroxide solution to a pH of 9.0. The selection of the target product is carried out by precipitation with acetone. Then it is washed with the same solvent until the excess gossypol or its adduct is completely removed and dried in air. The yield of the target product is 88%.

Specific data on examples of obtaining the proposed compounds 1-8 are shown in table 1.

An example of a dosage form 1. Tablets.

The tablets were prepared in the usual way, namely: by mixing the ingredients and tabletting on a tabletting machine. Examples of the quantitative composition of the tablets are shown in table 2.

table 2
Examples of the quantitative composition of the tablets Example No. one 2 3 Tablet weight 100 mg 150 mg 200 mg Components Amount mg % Amount mg % Amount mg % Active substance ^(*) 12 12 eighteen 12 24 12 Potato starch 10 10 fifteen 10 twenty 10 Calcium stearate 0.65 0.65 0.98 0.65 1.30 0.65 Ludipress 77.35 77.35 116.02 77.35 154.70 77.35 (*) - a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I)

When checking the solubility, it was found that when a tablet is dissolved in 500 ml of water at 100 revolutions of the stirrer per minute, 100% of the active substance passes into the solution in 45 minutes.

Treatment of children over the age of 6 with autistic disorders and severe cognitive impairment

The efficacy and safety of the use of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (I) in the complex treatment of children over the age of 6 years with autistic disorders and severe cognitive impairment were studied. Children took a drug based on a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (I) (tablets containing 12 mg of the active substance, the composition of which is shown in table 2) against the background of basic therapy with antipsychotics such as neuleptil, haloperidol , chlorpromazine, teraligen, triftazine, eglonyl, azaleptin or chlorprotixen. In some cases, antidepressants (e.g., anafranil) and anticonvulsants (finlepsin, trilleptal or topamax) were used. Antipsychotics, antidepressants and anticonvulsants were used in optimal therapeutic doses.

In the group of patients who received, in addition to basic therapy, a drug based on a sodium carboxymethyl cellulose copolymer with a degree of substitution of 0.35-0.80 and gossypol of formula (I), resistance to antipsychotic therapy decreased, especially in patients with extremely severe forms of autism. Prior to the introduction of a drug based on a sodium carboxymethyl cellulose copolymer with a degree of substitution of 0.35-0.80 and gossypol of formula (I), a positive therapeutic effect was not observed in these patients with an increase in the dose of antipsychotics, in some cases complications of the therapy in the form of loss of neatness skills were intensified (encopresis, enuresis). When a drug based on a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (I) was introduced into therapy, the manifestations of encopresis, enuresis stopped, catatonic disorders decreased, cognitive functions improved, speech appeared. With mild or moderate autism, behavioral stereotypes and one-sided autistic hobbies were removed. Against the background of taking the drug based on a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (I), the mental state of the patients improves. The use of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I) as part of the complex treatment of children with autistic disorders and severe cognitive impairment allows to remove the body's resistance to psychotropic drugs, which leads to the achievement of a therapeutic effect against a background of a decrease in a single and daily dosages for basic therapy drugs, to a significant improvement in patients' cognitive functions. The use of a preparation based on a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (I) does not have a negative side effect on the patient's body. The drug is well tolerated, toxic and allergic reactions are not registered. The results are presented in table.3. Thus, the present invention allows to obtain a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I) in a safe way with a high yield of the target product and to effectively use this product in the complex treatment of patients with autistic disorders and cognitive impairment.

Table No. 3 The research results obtained during the basic therapy (antipsychotics, antidepressants and anticonvulsants) and when the studied drug was included in the therapy. No. p / p Basic therapy Doses of drugs used for basic therapy (per day) Clinical and pharmacological group of drugs used The condition of the patient who has taken basic therapy, before the study drug is included in the therapy The patient's condition after a course of therapy with the study drug (daily dose 36 mg) CHILD PSYCHOSIS * one Teralen 2 mg Antipsychotic Moderately sick Easy sick 2 Teraliden 2.5 mg Antipsychotic Moderately sick Easy sick 3 Triftazine 7.5 mg Antipsychotic Moderately sick Easy sick Eglonil 50 mg Antipsychotic four Teraligen 1.25 mg Antipsychotic Moderately sick Easy sick Depakin Chrono 300 mg Anticonvulsant 5 Neuleptil 4 mg Antipsychotic Moderately sick Easy sick Triftazine 15 mg Antipsychotic Eglonil 150 mg Antipsychotic Amitriptyline 25 mg Antidepressant 6 Neuleptil 2 mg Antipsychotic Moderately sick Easy sick Eglonil 50 mg Antipsychotic Teralen 2.5 mg Antipsychotic Tegretol 100 mg Anticonvulsant

p / p Basic therapy Doses of drugs used for basic therapy (per day) Clinical and pharmacological group of drugs used The condition of the patient who has taken basic therapy, before the study drug is included in the therapy The patient's condition after a course of therapy with the study drug ATYPICAL CHILD PSYCHOSIS * one Chlorpromazine 50 mg Antipsychotic Moderately sick Easy sick Triftazine 5 mg Antipsychotic Eglonil 100 mg Antipsychotic Finlepsin 50 mg Anticonvulsant 2 Tizercin 37.5 mg Antipsychotic Extremely ill Seriously ill Teralen 4 mg Antipsychotic Convulex 140 mg Anticonvulsant 3 Chlorpromazine 25 mg Antipsychotic Extremely ill Seriously ill Triftazine 5 mg Antipsychotic Eglonil 50 mg Antipsychotic Finlepsin 200 mg Anticonvulsant four Teraligen 15 mg Antipsychotic Extremely ill Seriously ill Tizercin 12.5 mg Antipsychotic Convulex 200 mg Anticonvulsant 5 Teralen 6 mg Antipsychotic Moderately hard Seriously ill Convulex 180 mg Anticonvulsant is ill

6 Eglonil 150 mg Antipsychotic Moderately hard Moderately sick Haloperidol 0.2 mg Antipsychotic is ill Teraligen 5 mg Antipsychotic Aminosine 75 mg Antipsychotic Triftazine 15 mg Antipsychotic Azoleptin 12.5 mg Antipsychotic Depakin Chrono 150 mg Anticonvulsant 7 Treatment before the study drug is included in the therapy: Teraligen 15 mg Antipsychotic Seriously ill Triftazine 10 mg Antipsychotic Aminosine 50 mg Antipsychotic Convulex 300 mg Anticonvulsant Depakin Chrono 300 mg Anticonvulsant Cerebromine 1 tablet Nootropic Treatment when the study drug is included in the therapy: Triftazine 10 mg Antipsychotic Moderately hard Aminosine 50 mg Antipsychotic is ill Depakin Chrono 150 mg Anticonvulsant * Notes: according to the classification presented in the publication by V. M. Bashina “Autism in childhood” (see the link to this publication on page 2 of the description), the terms “child psychosis” and “atypical child psychosis” are equivalent to the terms “child autism” and “atypical childhood autism”

Claims (11)

1. A method of obtaining a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I):

where a: b: c = 1: (3-6) :( 5-7),
n = 40-50;
molecular weight of 120,000-130,000, including the interaction of an aqueous solution of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 with an aqueous solution of iodic acid or sodium periodate, followed by isolation of the carboxymethyl cellulose dialdehyde, treatment of the resulting product with gossypol or gossypeacetic acid, then an aqueous alkali solution and isolation of the target product by precipitation with an organic solvent, characterized in that the interaction of an aqueous solution of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 with an aqueous solution of iodic acid or sodium periodate is carried out while passing through the reaction solution of carbon dioxide until the pH of the solution is 3.0-4.5. 2. The use of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I):

where a: b: c = 1: (3-6) :( 5-7), n = 40-50;
molecular weight 120,000-130,000; in the complex treatment of patients with autistic disorders and cognitive impairment. 3. The use according to claim 2, where the copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (I) is obtained by the method according to claim 1. 4. The use according to claim 2 or 3, where the copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I) is used in combination with a means for treating cognitive disorders selected from one or more antipsychotics, antidepressants, anticonvulsants or combinations thereof. 5. A pharmaceutical composition intended for use in the treatment of patients with autistic disorders and cognitive impairment, containing as active ingredient a therapeutically effective amount of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I):

where a: b: c = 1: (3-6) :( 5-7),
n = 40-50;
molecular weight 120,000-130,000;
and pharmaceutically acceptable additives. 6. The pharmaceutical composition according to claim 5 of the following composition, wt.%:
active component formulas (1) 10.0-16.0 starch 10.0-20.0 calcium or magnesium stearate 0.6-0.8 ludipress up to 100 7. The pharmaceutical composition according to claim 5 or 6, intended for use in combination with an agent for the treatment of cognitive disorders selected from one or more antipsychotics, antidepressants, anticonvulsants, or combinations thereof. 8. The combination for the treatment of patients with autistic disorders and cognitive impairment, comprising a therapeutically effective amount of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I):

where a: b: c = l: (3-6) :( 5-7),
n = 40-50;
molecular weight 120,000-130,000;
or a pharmaceutical composition according to claim 5 or 6; and
a therapeutically effective amount of an agent for treating cognitive disorders selected from one or more antipsychotics, an antidepressant, an anticonvulsant, or a combination thereof. 9. A method of treating patients with autistic disorders and cognitive impairment, comprising administering to the patient a therapeutically effective amount of a sodium carboxymethyl cellulose copolymer with a degree of substitution of 0.35-0.80 and gossypol of formula (I):

where a: b: c = l: (3-6) :( 5-7),
n = 40-50;
molecular weight 120,000-130,000; or a pharmaceutical composition according to claim 5 or 6 in combination with a therapeutically effective amount of a cognitive disorder selected from one or more antipsychotics, an antidepressant, an anticonvulsant, or a combination thereof. 10. The use of a copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of the formula (I):

Where
a: b: c = 1: (3-6) :( 5-7),
t = 40-50;
molecular weight 120000-130000 to obtain a pharmaceutical composition according to claim 5 or 6. 11. The use of claim 10, where the copolymer of sodium carboxymethyl cellulose with a degree of substitution of 0.35-0.80 and gossypol of formula (I) is obtained by the method according to claim 1.